Be Your Best Self Questionnaire 2023 Step 1 of 4 25% Step 1 - Profile InformationName* First Last Email* 1. Age* Under 16 19-25 26-35 36-45 46-55 56-65 65-75 75+ and Wise 2. Gender* Female Male Step 2 - Current Vitality Profile1. How many hours a day do you work ? (be sure to include your commute, errands and child care/meal prep time) .* A. 8-10 B. 11-14 C. 15 or more 2. How many hours of sleep do you get a night, at least 5 out of 7 nights a week ?* A. 7-8+ B. 6-7 C. at least 5-6 D. 4-5 E. Less than 4 3. Is your sleep interrupted?* A. No, I fall asleep easily and stay asleep through the night B. I have difficulty either falling asleep OR staying asleep throughout the night C. I have some difficulty falling asleep AND staying asleep throughout the night 4. Do you have a workout routine?* A. Yes, and I follow it religiously B. Yes, but I tend to stray C. No, I used to but I don't have the time or desire to work out right now in my life. 5. After your finished exerting yourself either by working out or doing more physical activity than you’re used to do you feel* A. energized and refreshed B. tired but glad you did it C. exhausted 6. When you're feeling tired, do you routinely turn to food or drink for energy?* A. No, I try to exercise, take a shower, talk with friends or go outside for fresh air or take a nap. B. Yes, for example I fill up on unsweetened ice tea, a meal made up of protein/veggie/starch, crudite w hummus C. Yes, quick pick-me- like a coffee help before work, mid afternoon chips or evening popcorn or peanuts. 7. How many times a week do you/your family eat out?** A. 0 to 3 B. 3 to 5 C. They know our names at our local restaurants ☺ 8. If we were to peer inside your grocery cart, would we find mainly fresh, lean meats and produce—or bags, boxes, and cans of prepared foods?* A. Mainly fresh stuff B. About half and half C. Mainly packaged foods 9. Have you been under an unusual amount of stress in* A. the last 0-3 months B. 6 months to 1 year C. 1- 5 years D. 6-10 years E. 11-20 years 10. How many 8 oz cups of coffee do you drink a day ?* A. 0 B. 1 C. 2+ 11. How do you take your coffee ?* A. black B. with sugar or some kind of sweetener OR some kind of mild/creme/creamer C. with a sweetener AND some kind of milk/crème/creamer 12. Do you feel the need to connect with your friends?* A. Yes, I meet with my friends at least once a week B. Yes, but I don't seem to be able to find much time C. No, I have too many commitments to think about other people right now outside of my family. 13. Are you able to notice things around you that make you happy?* A. Yes, the scent of the fresh outdoors and nature or my children have the ability to lift my mood B. Yes, but they don't help when I'm tired. C. No. When I'm tired, I'm dead to the world. 14. Do you feel like the things you do in a day are meaningful ?* A. Yes I fell like I’m contributing to the greater good B. I feel like I should be but I’m not getting the most out of my days C. No, right now in my life, I feel like I’m just going through the motions What would you like to improve? Bloat Heartburn Elimination Mood (less mood swings, or irritability, or anxiousness, or feeling down) Focus Productivity Performance Energy Sleep Allergies Immune / Infections Joints Body Composition (less fat, more muscle, less inflammation) Endurance Strength Agility Less Cravings Food Habits Cooking Habits Workout Habits What bad habits do you want to break up with?What do you want to learn in this workshop? HOW DID I DO AND WHAT CAN I DO TO CHANGE SOMETHING RIGHT NOW. TOTAL NUMBER OF...A'sB'sC's, D's and E's How Did I Do? MOSTLY A's: You're doing great—keep up the good work! To boost your health quotient even more, take a look at any B or C answers you had and work toward improving them (e.g., more whole foods, more sleep) be grateful for all you do have and how hard your work to stay balanced and give to others without sacrificing your own health. MOSTLY B's: Looks like your doing pretty well—but you know there is room for improvement! Use the A answers as your guide to what to shoot for, and see if you can add in another exercise session per week, eat out less, or get out and enjoy the great outdoors more. Add gratitude into your daily life for all the good you have done, as you transition from work to home in the evening. MOSTLY C's: You seem to be struggling. Help is here! You might also want to look over the quiz's answers again: The A answers are a great goal but take it slowly! Trying to totally overhaul your eating and lifestyle habits all at once is a recipe for failure; it's just too much for anyone or any 'body' to handle. Make one small change at a time—say, eating at home one more time a week instead of going out or finding a local park or playground, even if it's a few miles away. Find someone who's lifestyle you admire. Sit down with them for lunch and ask them how they balance this part of their life. Believe and Do, You'll get there! We Look Forward To Seeing YOU at the Health and Wellness workshop By Stephanie Solaris, Founder and Director of Solaris Whole Health Be ready for a transformational and educational journey where myths will be challenged, and a new lens on health and nutrition will be revealed. This experience has the ability to change the way you live your life, and help set new expectations for yourself. And Bring your Questions for a Q&A you won't want to miss! For More Information feel free to visit us at www.solariswholehealth.com Please submit your survey below
